Custom Tool for Bonding Orthodontic Appliances, and Methods of Designing and Using Custom Tools

ABSTRACT

A custom tool for bonding orthodontic appliances in a mouth of a patient, the custom tool comprising: a facial body for a patient-specific, customized fit with the facial side of a plurality of teeth of the patient, a lingual body for a patient-specific, customized fit with the lingual side of the plurality of the teeth of the patient, wherein the lingual body. wherein the facial body and lingual body are configured to combine with the teeth of the patient to position orthodontic appliances on the plurality of teeth.

BACKGROUND

Orthodontic appliances such as brackets are used in orthodontictreatments for moving one or more teeth from an initial position(sometimes referred to as malposition or malocclusion) to a desiredposition in a patient's dentition. For example, by using an orthodontictreatment the patient's tooth may be moved such that their labial sidesare aligned with each other to achieve or maximize an aestheticallypleasant appearance of the overall dentition. Further in some cases, oneor more teeth may be moved to correct a malocclusion. The movement ofteeth is typically achieved by a pre-biased elastic arch wire, which isattached via brackets to the teeth, and which applies a force to theteeth toward the desired position over a longer time period. The ends oforthodontic arch wires are often connected to small appliances known asbuccal tubes that are, in turn, secured to the patient's molar teeth. Inmany instances, a set of brackets, buccal tubes and an arch wire isprovided for each of the upper and lower dental arches of the patient.

In many types of orthodontic techniques, the precise position of theorthodontic appliances on the teeth is an important factor for helpingto ensure that the teeth move to their intended final positions. Forexample, one common type of orthodontic treatment technique is known asthe “straight-wire” technique, where the arch wire lies in a horizontalplane at the conclusion of treatment. If, for example, a bracket isattached to the tooth at a location that is too close to the occlusal orouter tip of the tooth, the orthodontist using a straight-wire techniquewill likely find that the tooth in its final position is undulyintruded. On the other hand, if the bracket is attached to the tooth ata location closer to the gingiva than is appropriate, it is likely thatthe final position of the tooth will be more extruded than desired.

Certain treatment planning systems have been used to determine thedesired position of the teeth in a computer simulation in advance of anyactual treatment. Such a planning system helps for example for avoidingcollisions between the teeth and brackets in tooth positions outside theinitial position, and further allows for the brackets and the arch wireto be designed and arranged to match with a variety of clinicalsituations, for example with the position of the teeth in the initialposition, in the desired position, and positions between. For lingualbrackets, such treatment planning is widely used. Lingual brackets oftenhave a customized design individually for every tooth and patientbecause, other than the labial surfaces of a tooth, the lingual surfacesgreatly vary in shape relative to each other so that a “one size fitsall” bracket shape typically cannot be used. Some treatment planningsystems also allow for designing such customized brackets whichprecisely match a tooth surface and the required clinical situations ofa patient. Accordingly, customized brackets typically have to beprecisely placed at positions on the teeth which are predeterminedduring the treatment planning For facilitating a precise placement ofthe brackets on a patient's teeth and for the orthodontist's reference,the brackets are often provided prepositioned on a plaster modelreplicating the patient's teeth. One example of a treatment planningsoftware is disclosed in PCT Publication WO 2001/80761 “InteractiveOrthodontic Care System Based on Intra-oral Scanning of Teeth.” Asdisclosed, the treatment planning software virtually superimposesbrackets on teeth to generate a three-dimensional model comprising thethree-dimensional tooth objects plus the virtual brackets at theirintended locations. This three-dimensional model is supplied to astereolithography (SLA) instrument for additive manufacturing a plasticmodel of the teeth with the brackets superimposed thereon. Athermoplastic foil is placed above the SLA model and the model and foilare placed within a pressure chamber. The chamber is pressurized so thatthe foil envelops the dentition and the brackets. The foil thus obtainssmall indentations where the brackets can be located.

A plaster model on which the brackets are placed is sometimes used inorthodontics to make a so-called “transfer tray” for facilitating theplacement of the bracket on a patient's teeth. A transfer tray typicallyis adapted to hold a complete set of brackets at the predeterminedposition and allow the brackets to be placed and bonded on the teeth allat once, in one step, during “indirect bonding.”

In general, indirect bonding techniques involved the use of a transfertray having a shape that matches the configuration of at least part of apatient's dental arch. A set of orthodontic appliances such as bracketsare releasably connected to the tray at certain, predeterminedlocations. Adhesive is applied to the base of each appliance, and thetray is then placed over the patient's teeth until the adhesive hardens.Next, the tray is detached from the teeth as well as from theappliances, with the result that all the appliances previously connectedto the tray are now bonded to the respective teeth at their intended,predetermined locations. One example of a method of making a transfertray for orthodontic appliances is disclosed in published EuropeanPatent Application No. 1 2196 586, “Mockup Representing a Dental ArchIncluding Analogs Approximating Orthodontic Brackets and Method ofMaking the Mockup.” Another example of a method of making a transfertray for orthodontic appliances is disclosed in U.S. Pat. No. 9,763,750“Rapid Prototyped Transfer Tray for Orthodontic Appliances.”

Although certain advances have been made in methods of predetermininglocations of orthodontic appliances on a patient's teeth and tools forplacement thereof, additional advancements are desired by orthodontistsand their patients.

SUMMARY

This disclosure relates to custom tools for bonding orthodonticappliances in a mouth of a patient, techniques for producing such customtools and methods for dental restoration, and methods of bondingorthodontic appliances in a mouth of a patient.

In one example, the disclosure is directed to a custom tool for bondingorthodontic appliances in a mouth of a patient. The custom toolcomprises: a facial body for a patient-specific, customized fit with thefacial side of a plurality of teeth of the patient, wherein the facialbody includes an appliance positioning portion and a first engagementportion extending away from the appliance positioning portion; a lingualbody for a patient-specific, customized fit with the lingual side of theplurality of the teeth of the patient, wherein the lingual body includesa first engagement portion; wherein the first engagement portion of thefacial body interlocks with the first engagement portion of the lingualbody; and wherein the facial body and lingual body are configured tocombine with the teeth of the patient to position orthodontic applianceson the plurality of teeth.

In another example, the disclosure is directed to a method of bondingorthodontic appliances in a mouth of a patient. The method comprises:positioning a patient-specific lingual body adjacent a plurality ofteeth of a patient to receive orthodontic appliances, wherein thelingual body has customized fit with the lingual side of the teeth ofthe patient, wherein the lingual body includes a first engagementportion, and; positioning a patient-specific facial body adjacent theplurality of teeth, wherein the facial body has a customized fit withthe facial side of the teeth of the patient, a first engagement portion,and a plurality of receptacles each holding an orthodontic appliancealigned with the plurality of teeth; interlocking the first engagementportion of the facial body with the first engagement portion of thelingual body to combine with the teeth of the patient to position theorthodontic appliances on the plurality of teeth; bonding theorthodontic appliances to the teeth; and removing the facial and lingualbodies from plurality of teeth.

In yet a further example, this disclosure is directed to a method ofdesigning a custom tool for bonding orthodontic appliances in a mouth ofa patient. The method comprises: receiving, by one or more processors,three-dimensional scan data including supragingival tooth structure of apatient; designing, by the one or more processors, a custom tool forprecise placement of orthodontic appliances on the patient's teeth basedon the three-dimensional scan data of the supragingival tooth structureof the patient; designing, by the one or more processors, theorthodontic appliance receptacles to provide desired location andorientation of orthodontic appliances on the tooth structure of thepatient; wherein the tool comprises: a facial body for apatient-specific, customized fit with the facial side of a plurality ofteeth of the patient, wherein the facial body includes an orthodonticappliance positioning portion and a first engagement portion extendingaway from the positioning portion; a lingual body for apatient-specific, customized fit with the lingual side of the pluralityof teeth of the patient, wherein the lingual body includes a firstengagement portion extending away from the custom fitting portion;wherein the first engagement portion of the facial body interlocks withthe first engagement portion of the lingual body; and wherein the facialbody and lingual body are configured to combine with the teeth of thepatient to position orthodontic appliances on the plurality of teeth.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front view of an embodiment of a facial body that may be apart of a custom tool for bonding orthodontic appliances;

FIG. 2 is a back view of the facial body of FIG. 1 ;

FIG. 3 is bottom view of the facial body of FIG. 1 ;

FIG. 4 is a front view of an embodiment of a lingual body that may be apart of a custom tool for bonding orthodontic appliances;

FIG. 5 is a back view of the lingual body of FIG. 4 ;

FIG. 6 is a bottom view of the lingual body of FIG. 4 ;

FIG. 7 is a perspective view of the facial body of FIG. 1 and thelingual body of FIG. 4 prior to interlocking them together;

FIGS. 8 a and 8 b are bottom views convenient for showing how the facialbody of FIG. 1 and the lingual body of FIG. 4 may interlock together toform an embodiment of custom tool for bonding orthodontic appliances;

FIG. 9 is a perspective view of the custom tool of FIG. 8 b;

FIG. 10 is a bottom view of the custom tool of FIG. 9 in the mouth of adental patient;

FIGS. 11 a-11 c illustrate example steps for using the tool of FIG. 9 toposition and bond orthodontic appliances in the mouth of the orthodonticpatient; and

FIG. 12 is a perspective view of another embodiment of a custom tool forbonding orthodontic appliances in an orthodontic patient's mouth.

The following embodiments are intended to be illustrative of the presentdisclosure and not limiting.

DETAILED DESCRIPTION

The primary objective of orthodontics is to move a patient's teeth to aposition where the teeth are in proper function and estheticallypleasing. Orthodontic treatment may include standardized brackets andwires, such as those components in a “straight-wire” appliance system.Conventional orthodontic appliances such as brackets are positioned byhand by an orthodontist in defined positions and orientations accordingto standardized placement rules. The orthodontist may also visuallygauge proper bracket positions and imagining treatment outcomes. Afterplacement is determined, the brackets are then bonded by a smallquantity of adhesive placed on the base of each bracket. The bracket maybe bonded to the tooth using either a two-part chemical cure adhesive ora one-part light-cure adhesive. The uncured adhesive is sufficientlyviscous and tacky to allow temporary adhesion and visual adjustmentprior to final bonding. This method of bracket placement is known as“direct bonding.” To save time and ease of handling, some brackets areoffered as Adhesive Pre-Coated (APC) commercially available from 3MCompany, St. Paul, Minn., which include uncured adhesive on the bracketbases when they come from the factory. Once the orthodontic appliancesare bonded on the teeth, the combination of the arch wire andorthodontic appliances adjusted over time move the teeth towards theirintended final position.

A skilled orthodontist may become very good at visually gauging properbracket positions and imagining treatment outcomes for patients.However, it can take many years to acquire this skill, and even then,manual wire bends and bracket repositioning may be needed later intreatment to correct minor placement errors and achieve better results.

The present invention provides custom tools for direct bondingorthodontic appliances. These custom tools are formed using virtualtreatment planning software often used in the indirect bonding processto provide accurate bracket placement, but include the advantage ofdirect bonding the appliances normally to the teeth surface, whichprovides good bond reliability. One possible disadvantage of indirectbonding is that the orthodontic appliance slides over the facial orlingual surface of the tooth in an occluso-gingival direction, thussmearing or wiping adhesive off the bracket base before coming to restin its target position on the tooth. This may result in a poor bondbetween the orthodontic appliance and the tooth, requiring rebonding orreplacements, ineffective treatment, or unintentionally consumedappliances. Another disadvantage of indirect bonding is that it requireseither the delicate additional step of preloading the orthodonticappliances into the transfer tray in such a way that they are releasablyconnected to the tray at certain, predetermined locations, or creationof a physical model of the patient's dentition, application of thebrackets to the model and creation of the indirect bonding template onthe model. Either way, these are time consuming and technique sensitiveprocedures.

The dental custom tools of the present invention do not have thedisadvantages of the indirect bonding tray and placement procedure. Thecustom tools of the present invention also provide more accurateplacement of the orthodontic appliances, including more accuratemeasurement and analysis in comparison to direct bonding by hand. Inaddition, the custom tools and use thereof provides reduceddoctor/patient time in the chair and better treatment outcomes. In fact,the orthodontist may be able to delegate the procedure for bonding theorthodontic appliances to another sufficiently qualified staff memberbecause the planning of the position of each appliance is removed fromthe chairside procedure.

Although the custom tools of the present invention do not allow forplacement and bonding of the orthodontic appliances all at once, likeindirect bonding procedures and templates, they allow for greatercontrol over adhesive delivery because the orthodontic appliances arebonded one at a time, instead of all at once. For example, the customtools provide greater control over the finer aspects of orthodonticplacement, such as controlling of the potential excess of filledadhesive (i.e., flash) from around the base's perimeter and forming asmooth film of adhesive between the base and the tooth. Also, if abracket is lost or damaged by the patient, it can be easily re-bondedusing the original custom tool with a new bracket.

In addition, compared to indirect bonding trays and placementprocedures, the custom tools of the present invention provide greatervisibility to more easily determine if the template and/or the bracketsare positioned correctly on the teeth. This is because there is lessmaterial obscuring the brackets in visual reference to the teeth. Also,some indirect bonding trays, such as those formed from silicone, may bedamaged after a single use due to the sharp undercut features of thebrackets (e.g. hooks & tie-wings) tearing the bracket receptacles as thetray is removed after bonding. In other words, such trays can be damagedby a single use. This can potentially render the tray unable to holdbrackets accurately in their intended positions when used tosubsequently re-bond brackets due to bond failure or loss duringtreatment. In contrast, the custom tools of the present invention arereusable, providing the option to rebond certain brackets using the samecustom tool template. Lastly, the custom tools may be digitally designedand printed using additive manufacturing to provide a patient-specific,customized tools.

The primary objective of orthodontics is to move a patient's teeth to aposition where the teeth are in proper function and estheticallypleasing. Orthodontic treatment may include standardized brackets andwires, such as those components in a “straight-wire” appliance system.Conventional orthodontic appliances such as brackets are positioned byhand by an orthodontist in defined positions and orientations accordingto standardized placement rules. The orthodontist may also visuallygauge proper bracket positions and imagining treatment outcomes. Afterplacement is determined, the brackets are then bonded by a smallquantity of adhesive placed on the base of each bracket. The bracket maybe bonded to the tooth using either a two-part chemical cure adhesive ora one-part light-cure adhesive. The uncured adhesive is sufficientlyviscous and tacky to allow temporary adhesion and visual adjustmentprior to final bonding. This method of bracket placement is known as“direct bonding.” To save time and ease of handling, some brackets areoffered as Adhesive Pre-Coated (APC) commercially available from 3MCompany, St. Paul, Minnesota, which include uncured adhesive on thebracket bases when they come from the factory. Once the orthodonticappliances are bonded on the teeth, the combination of the arch wire andappliances adjusted over time move the teeth towards their intendedfinal position.

A skilled orthodontist may become very good at visually gauging properbracket positions and imagining treatment outcomes for patients.However, it can take many years to acquire this skill, and even then,manual wire bends and bracket repositioning may be needed later intreatment to correct minor placement errors and achieve better results.

The present invention provides custom tools for bonding orthodonticappliances. All the orthodontic appliances may be applied at once,sequentially, or one at a time to the patient's teeth. These dentaltemplate are formed using virtual treatment planning software often usedin the indirect bonding process to provide accurate bracket placement,but include the advantage of direct bonding the appliances normally tothe teeth surface, which provides good bond reliability.

One possible disadvantage of indirect bonding is that the orthodonticappliance slides over the facial or lingual surface of the tooth in anoccluso-gingival direction, thus smearing or wiping adhesive off thebracket base before coming to rest in its target position on the tooth.This may result in a poor bond between the orthodontic appliance and thetooth, requiring rebonding or replacements, ineffective treatment, orunintentionally consumed appliances. Another disadvantage of indirectbonding is that it requires the either delicate additional step ofpreloading the orthodontic appliances into the transfer tray in such away that they are releasably connected to the tray at certain,predetermined locations, or creation of a physical model of thepatient's dentition, placement of the brackets on the model and creationof the indirect bonding template on the model. Either way, these aretime consuming and technique sensitive procedures.

The custom tool for bonding orthodontic appliances of the presentinvention does not have the disadvantages of the indirect bonding trayand placement procedure. The custom tools of the present invention alsoprovide more accurate placement of the orthodontic appliances, includingmore accurate measurement and analysis in comparison to direct bondingby hand. In addition, the custom tools and use thereof provides reduceddoctor/patient time in the chair and better treatment outcomes. In fact,the orthodontist may be able to delegate the procedure for bonding theorthodontic appliances to another sufficiently qualified staff memberbecause the planning of the position of each appliance is removed fromthe chairside procedure.

The custom tools of the present invention may be reusable for the samepatient, providing the option to rebond certain brackets using the samecustom tools. For example, the bracket can be easily rebonded if theinitial attempt fails. For rebonding later in treatment after toothmovement has begun, the template can be sectioned to allow an individualbracket to be rebonded using reference features (e.g. occlusal surface)of the individual tooth. In addition, the present invention allows thebracket to approach the tooth from a direction substantiallyperpendicular to the facial surface of the tooth, eliminating theproblem of sliding adhesive across the facial surface of the tooth priorto curing. The digitally designed custom tool also allows brackets to beplaced precisely on the teeth with a nonuniform adhesive thickness (e gthinner on mesial than distal) that can be useful when customizingtreatment for a patient using noncustom appliances.

The custom tools described herein may include features designed toprovide interferences between the two primary portions of the tool andcertain engagement portions which interlock, which overall helps withpreventing relative movement between the portions in multipledirections, helps with better clamping of the tool to the orthodonticpatient's teeth and for positioning the two portions together toprecisely locate orthodontic appliances on the patient's teeth atpredetermined locations and orientations. Such interferences aredigitally designed into the custom body is when it is designed andproduced. Traditional dental tool bodies do not have digitally designedinterferences. In order to interlock together or separate the twoportions from each other, they may need to deform or bend. In addition,the tools described herein may eliminate the need for external tools,and are instead self-contained and thus, quicker and simpler to installon a patient's teeth. In addition, captive doors provide a reduction ofindividual parts that need to be assembled, and decreasing thelikelihood of losing individual parts. Lastly, the tools describedherein provide more precise control over the placement and bonding oforthodontic appliances on the patient's teeth at predetermined locationsand at predetermined orientations compared to practitioners using moretraditional skills, tools and techniques.

Each custom tool 10 is custom designed to fit a certain patient(“patient specific”), and thus has a customized fit with a plurality ofteeth 72 in the patient's dental arch. The custom tool is speciallydesigned to register and fit onto a specific patient's dental arch. Toachieve this, the custom tool described herein may be digitallydesigned. For example, a tool may be designed using a three-dimensional(3D) model of the patient's tooth structure (e.g., obtained from anintraoral scan of all or part of the patient's dentition or scanning ofa conventional impression or model). The tool can be, for example,manufactured from the digital data using an additive technique, such as3D printing, or a subtractive technique, such as CAD/CAM milling.

The disclosed techniques help facilitate high quality orthodonticappliance bonding to the patient's teeth with improved precision,reduced time and/or skill requirements, compared to conventional bondingtechniques.

FIGS. 1, 2, and 3 illustrate an embodiment of a facial portion 12 of thecustom tool 10 of the present invention. FIGS. 4, 5, and 6 illustrate anembodiment of a lingual portion 14 of the custom tool 10 of the presentinvention. “Facial” as used herein, including the claims, refers to thedirection directed toward the cheeks or lips (i.e., the buccal andlabial) of the patient, and opposite the lingual direction. “Lingual” asused herein, including the claims, refers to the direction directedtoward the tongue of the patient, and opposite the facial direction.FIGS. 7, 8 a, 8 b, and 9 illustrate how the facial and lingual portions12, 14 fit together to form a complete a patient-specific, custom tool10 for bonding orthodontic appliances 80.

FIGS. 1-3 are views of one embodiment of the facial body 12 of customtool 10 for bonding orthodontic appliances 80, such as brackets, inpredetermined locations and at predetermined orientations. The tool 10includes a facial body 12, which may be configured to provide acustomized fit with the patient's dental arch. For example, facial body12 may be specifically designed to fit next to, mate with, the facialsurfaces of the patient's teeth. In the example shown in FIG. 1 , thefacial body 12 includes an appliance positioning portion 16 and anengagement portion 18. A practitioner uses the appliance positioningportion 16 of the custom tool 10 to position and then bond theorthodontic appliances 80 to the teeth in the mouth of the patient. Theorthodontic appliances 80 are held in place within specially designedreceptacles. The receptacles may be of any form that receive andcorrectly position the orthodontic appliances on their correspondingteeth in predetermined locations on the teeth and in predeterminedorientations relative to the teeth. The Figures illustrate thereceptacles in two different embodiments, open receptacles 90 orpartially enclosed receptacles 100, but other embodiments may beenvisioned by those skilled in the art. Both types of receptacles areexplained in more detail below.

In order to place the orthodontic appliances precisely, it is preferableto have a tight fit between the facial body 12, lingual body 14, and thepatient's teeth. In certain situations, the facial and lingual bodiesmay be relieved from full conformance to the teeth to provide access forinsertion and to avoid excessive undercuts during application to themaloccluded teeth. To assist in securing the template to the teeth,there are two engagement portions 18 a, 18 b positioned at opposite endsof the appliance positioning portion 16. This is ideal, but notnecessary. For example, the facial body 12 could include just oneengagement portion 18 positioned adjacent the appliance positioningportion16. However, in custom tools 10 having two engagement portions 18a, 18 b, this provides two points of interlock between the lingual andfacial bodies 12, 14.

The first engagement portion 18 a and second engagement portion 18 bboth extend away from the appliance positioning portion 16. In theillustrated embodiment, the engagement portions 18 extend at a generallyright angle relative to the appliance positioning portion 16. Whencompared to the patient's mouth, which includes an occlusal plane showngenerally by line A-A (in FIG. 2 ) the engagement portions 18 preferablyextend generally perpendicular to such occlusal plane.

The length of the engagement portions 18 may extend some distance fromthe appliance positioning portion 16 of the facial body 12. The lengthof the engagement portions 18, 19 may be customized and optimized forthe individual patient. If the engagement portions are too long, theywill stretch the patient's jaw, making it uncomfortable or painful forthe patient. If the engagement portions are too short, the facial body12 will disengage from the patient's teeth. In one embodiment, thelength of the engagement portions may be 1 mm to 5 cm in length.However, it may depend on where exactly the engagement portions arelocated in the patient's mouth. They may be longer, if they are attachedto the patient's teeth near the front of the mouth, such as theincisors. They may be shorter, if they are attached to the back of themouth, like the molars. Also, the patient's overall opening distancebetween the upper and lower arches of teeth is a consideration.

As illustrated in FIG. 3 , engagement portions 18 of the facial body 12may include a variety of engagement surfaces configured to mateappropriately with the engagement surfaces on a lingual body 14.Engagement portions 18 a, 18 b of the facial body 12 may include aprotrusion 20 a, 20 b respectively or some other mechanism known in theart for interlocking with the lingual body 14. in the illustratedembodiment, protrusion 20 includes a first engagement surface 24, asecond engagement surface 26, and a third engagement surface 28.Protrusions 20 a, 20 b are sized and shaped to interlock or snap fitwith the indentations 30 a, 30 b in the lingual body 14. Alternatively,engagement portions 18 of the facial body 12 could include a protrusionon one end and an indentation on the opposite end, and the lingual body14 could include an indentation on one end and a protrusion on theopposite end, to allow the two bodies 12, 14 to interlock together.Various structures known in the art may be substituted for theprotrusion 20 and indentations 30, so long as they assist in securelyinterlocking the facial body 12 to the lingual body 14. For example,dovetail vertical slides or button and snaps may also be used asinterlocking features of the engagement portions.

The engagement portions 18 a, 18 b of the facial body 12 are structuredto engage with or interlock with the engagement portions 31, 32, and 33on the lingual body 14, as explained in more detail below in referenceto FIGS. 7, 8, and 9 .

In the illustrated embodiment, the appliance positioning portion 16 issized and shaped to mate with the facial surfaces of the anterior teethof a patient. The engagement portions 18 are sized and shaped beadjacent to the posterior teeth.

In the example shown in FIG. 1 , the facial body 12 includes one or morereceptacles, illustrated as either open receptacles 90 (or apertures) orpartially enclosed receptacles 100 on doors 40. Each open receptacle 90is positioned over a portion of a facial surface of a respective toothof the patient that is to receive an orthodontic appliance. Each of theapertures 34 has a suitable receptacle 100 for receiving and holding anorthodontic appliance 80. When door 40 is mated with a respectiveaperture 34, the surface 42 of the door 40 and the base 82 of theorthodontic appliance 80 are closely aligned with the surface of thetooth 72 that is to receive an orthodontic appliance. Regardless ofwhich type of receptacle is used, the modeling software is used todesign the shape and orientation of the receptacle to assist in aligningthe base of the orthodontic appliance 80 at the ideal location on theindividual tooth.

The receptacle 90 may include a substantially enclosed perimeter, asillustrated in the Figures. The substantially enclosed perimeter couldbe sized and shaped to closely outline the base 82 of the specificorthodontic appliance 80 intended for placement therein. Alternatively,the substantially enclosed perimeter could be sized and shaped in aparticular segment of the receptacle 90, to help guide the orthodontistto bond the appliance 80 to the correct location on the tooth. Forexample, the open receptacles 90 may be enlarged (not shown) along oneor more edges to allow the brackets clearance as the custom template 10is removed from the teeth. In this case, the open receptacles 90 couldinclude at least one surface or edge configured to engage an edgefeature of the base 82 of the corresponding orthodontic appliance 80.The surfaces or edges of each receptacle help guide the position andorientation of the bracket or orthodontic appliance 80 on the toothsurface, according to the digital treatment plan. Depending on theintended direction of motion of the custom tool 10 during removal afterbonding, different edges may be enlarged and by varying shapes anddistances so as to avoid interference with the brackets 90.

The facial body 12 may have individual doors 40 each with its ownreceptacle 100 and all sized to closely fit with corresponding apertures34. The shape of one or more of apertures 34 for mating with the doors40 may be designed to substantially match the shape of the tooth. Eachdoor 40 may be attached to the facial body 12 as illustrated with ahinge 48 and hinge pin 46 at one end, and an attachment mechanism 44 atthe other end. The attachment mechanism 44 in this case is a clip 44which is designed to clip over or snap onto an engagement surface 43(shown in FIGS. 5 and 6 ) on the lingual body 14. As such, the hinge 48and hinge pin 46 are adjacent the gingiva of the patient's teeth and theclip 44 and engagement surface 43 are adjacent the occlusal surfaces ofthe patient's teeth or located proximate an incisal edge of a tooth orteeth. This arrangement is convenient for the clip to snap under theocclusal surfaces or incisal edge of the patient's teeth, spaced awayfrom their tongue. However, in other embodiments not illustrated, theirrelative positions may be reversed, with the clip 44 and engagementsurface 43 adjacent the gingiva of the patient's teeth and hinge 48 andhinge pin 46 adjacent the incisal or occlusal surfaces of the patient'steeth.

In the illustrated embodiment, the door body 40 and facial body 12 aremechanically connected to each other by using a hinge 48 and hinge pin.This configuration helps maintain proper alignment between the door body40 and corresponding aperture 34 during use of custom tool 10. However,door body 40 and facial body 12 may be connected via a snap hinge, aliving hinge, a barrel hinge, a pin joint hinge, or any other suitabletype of hinge. Door hinge 48 and hinge pin 46 may be formed separatefrom the door body 40 and/or facial body 12, or door hinge 48 and hingepin 46 may be formed as an integral part of door body 40 and/or facialbody 12.

The facial body 12 may include a first alignment member 52, whichassists in properly aligning the facial and lingual bodies 12, 14 beforeinterlocking them together. In the illustrated embodiment, the firstalignment member 52 is a post that is sized to fit with the secondalignment member 54 in the lingual body 14, shown as a slot 55 in FIGS.4-6 .

The facial body 12 may include a custom gingival surface 36 that isgenerally contoured to match the gingiva, but not engaging the gingiva.The facial body 12 may also include a facial rib 38 to provide overallstrength to the facial body.

Custom tool 10 may include a lingual body 14, which may also beconfigured to provide a customized fit the teeth of the patient. FIGS.4, 5, and 6 illustrate views of one embodiment of the lingual body 14.Facial body 12 and lingual body 14 are configured to combine with theteeth of the patient to correct seat the orthodontic appliances on thepatient's teeth. The lingual body 14 is separable from and engageablewith the facial body 12, while maintaining the integrity of therespective bodies, through use of their engagement portions 18, 19.

In the example shown in FIGS. 4-6 , the lingual body 14 includes acustom fitting portion 17 and an engagement portion 19. An orthodontistuses the custom fitting portion 17 of the custom tool to closely alignand engage with the labial surfaces of the patient's teeth. In theillustrated embodiment, there are two engagement portions 19 a, 19 bpositioned at opposite ends of the custom fitting portion 17. This isideal, but not necessary. For example, the lingual body 14 could includejust one engagement portion 19 positioned adjacent the custom fittingportion 17. However, in custom tools 10 having two engagement portions19 a, 19 b, this provides two points of interlock between the facial andlingual bodies 12, 14, respectively.

Lingual body 14 includes first engagement portion 19 a and secondengagement portions 19 b. The engagement portions 19 a, 19 b of thelingual body 14 are structured to engage with or interlock with theengagement portions 18 a, 18 b on the facial body 12, as explained inmore detail below in reference to FIGS. 7, 8, and 9 .

The first engagement portion 19 a and second engagement portion 19 bboth extend away from custom fitting portion 17. In the illustratedembodiment, the engagement portions 19 extend at a generally right anglerelative to the custom fitting portion 17. When compared to thepatient's mouth, which includes an occlusal plane illustrated asreference line A-A (shown in FIG. 6 ), the engagement portions 19 extendgenerally perpendicular to the occlusal plane.

As illustrated in FIG. 6 , engagement portions 19 of the lingual body 14may include a variety of engagement surfaces configured to mateappropriately with the engagement surfaces 24, 26, 28 on the facial body12. Engagement portions 19 a, 19 b of the lingual body 14 may include anindentation 30 a, 30 b respectively or some other mechanism known in theart for interlocking with the facial body 12. In the illustratedembodiment, indentation 30 includes a first engagement surface 31, asecond engagement surface 32, and a third engagement surface 33.Indentations 30 a, 30 b are sized and shaped to interlock or snap fitwith the protrusions 20 a, 20 b in the facial body 12. Variousstructures known in the art may be substituted for the indentations 30and protrusion 20, so long as they assist in securely interlocking thelingual body 14 to the facial body 12.

In the illustrated embodiment, the custom fitting portion 17 is sizedand shaped to mate with the anterior teeth of a patient. The engagementportions 19 are sized and shaped to be adjacent the posterior teeth.

The lingual body 14 includes a plurality of an engagement surfaces 43adjacent the occlusal surfaces of the patient's teeth or locatedproximate to the teeth to receive an orthodontic appliance 80. Thisarrangement is convenient for the clip 44 (shown in FIGS. 1-3 ) to snapunder the occlusal surfaces or incisal edge of the patient's teeth,spaced away from their tongue. However, in other embodiments notillustrated, the engagement surface 43 may instead be adjacent thegingiva of the patient's teeth, with the clip 44 likewise being in asimilar position.

The lingual body 14 may include a custom lingual rib 39 to provideadditional clamping or mating to the individual patient's mouth.

The lingual body 14 may include a second alignment member 54 sized andshaped to fit with the first alignment member 52. In the illustratedembodiment, the second alignment member 54 may be mesial alignmentreceptor. Specifically, the second alignment member may be a slot 55sized to receive the post 52 on the facial body 12.

FIGS. 8 a, 8 b , 9 and 10 are useful for illustrating how the facialbody 12 and lingual body 14 are assembled together and around the teethof a patient to position the orthodontic appliances 80 within thereceptacles 90, 100 of the tool 10 at precise locations on the teeth.One of the major benefits of this design is that once assembled,movement between the facial body and the lingual body is restricted inmultiple directions and multiple rotations. As a result, orthodontistsare able to more accurately place and bond the orthodontic bracket inideal locations on the teeth of for their patients.

With FIGS. 8 a and 8 b as a point of reference, an orthodontist mayfirst place the lingual body 14 behind the patient's teeth, with thesecond alignment member 54 centered adjacent the occlusal surfaces ofthe patient's teeth. Then, the practitioner may place the facial body 12over the front of the teeth and align the first alignment member 52, thepost, to fit into the second alignment member 54, the hole. However, inother embodiments, bodies 12, 14 could include indicia or alignmentfeatures (e.g., visual indicators, other forms of mechanical matingfeatures, keyholes, notches, and the like) to help a practitionerproperly align and easily engage facial body 12 and lingual body 14 withone another and with the patient's teeth.

The facial and lingual bodies 12, 14 are preferably made of flexiblematerials to bend them at certain radiuses to successfully interlockthem together, as illustrated in FIGS. 8 a and 8 b . An orthodontistwill interlock the bodies 12, 14 together by placing the protrusions 20a, 20 b into the corresponding indentations 30 a, 30 b. The release tabs22 a, 22 b may optionally be used to help fit protrusions 20 a, 20 binto the indentations 30 a, 30 b. Custom tools can be made from the fullrange of 3D printed materials, molded polymeric material or CAD/CAMshaped polymeric materials having certain desired strength, flexibility,translucency, or color. For example, the material can be polymericmaterial that may be transparent, translucent, or opaque. In someembodiments, clear or substantially transparent polymeric material thatmay include, for example, one or more of amorphous thermoplasticpolymers, semi-crystalline thermoplastic polymers, transparentthermoplastic polymers, and thermoset polymers. Thermoplastics can bechosen from polycarbonate, thermoplastic polyurethane, acrylic,polysulfone, polyprolylene, polypropylene/ethylene copolymer, cyclicolefin polymer/copolymer, poly-4-methyl-1-pentene orpolyester/polycarbonate copolymer, styrenic polymeric materials,polyamide, polymethylpentene, polyetheretherketone and combinationsthereof. In another embodiment, the body material may be chosen fromclear or substantially transparent semi-crystalline thermoplastic,crystalline thermoplastics and composites, such as polyamide,polyethylene terephthalate. polybutylene terephthalate,polyester/polycarbonate copolymer, polyolefin, cyclic olefin polymer,styrenic copolymer, polyetherimide, polyetheretherketone,polyethersulfone, polytrimethylene terephthalate, and mixtures andcombinations thereof. In some embodiments, the body is a polymericmaterial chosen from polyethylene terephthalate, polyethyleneterephthalate glycol, poly cyclohexylenedimethylene terephthalateglycol, and mixtures and combinations thereof. In additional embodimentsthermoset polymers include acrylics, urethanes, esters, silicones,thiolenes, epoxies, olefin metathesis and combinations thereof. Further,it may be advantageous to coat the fabricated template with a releasecoating (e.g. parylene) to facilitate easy removal of the template afterbonding.

FIG. 8 b is convenient for describing the clamping force that can begenerated between the facial body 12 and the lingual body 14. The facialbody 12 has a certain arch length (C, and the lingual body 14 has acertain arch length (D). When the custom tool 10 is made, the geometryof the facial and/or lingual bodies 12, 14 is altered. For instance, thearch length C of the facial body 12 may be shortened, while the archlength D of the lingual body is maintained, and this configurationcreates a clamping force between the two bodes 12, 14 when they areassembled. In addition, the lingual bodies 12, 14 are sufficientlystrong so as not to break or buckle, and the protrusion 20 and theindentation 30 can be interlocked without creating undue pressure in themouth of the patient. Clamping forces can also be generated by slightlyreducing the radius of curvature of the facial body 12, whilemaintaining the radius of curvature of the lingual body 14. Angle 0illustrates the latching surface relative to the arch tangent.

The degree of clamping force between the facial body 12 and the lingualbody 14 should be tailored to balance the security of the installed tool10 around the patient's teeth and sealing it against the gingivaltissues with ease of installation into and removal from the patient'smouth. The degree of clamping force can be increased by increasing thestiffness of the bodies 12, 14 via materials, geometry the amount ofshortening of the facial body 12, and/or reduction of the radius ofcurvature of the facial body 12. Modifications to the bodies 12, 14 canbe applied across the bodies, for instance by applying an appropriateshrinkage factor, or they can be applied locally to various regions ofthe bodies and/or latching mechanism between the two. Latch securementand ease of engagement and removal can be tailored by adjusting thelatching angle, length of the latching surfaces (engagement surface) 3132, 33 and topography of the surfaces 24, 26, 28 to obtain the bestbalance of performance. Tools such as finite element modeling can beused to predict the appropriate parameters for a given custom tool basedon test results of previously tested cases. Machine learning can beapplied to improve prediction capability over time, including feedbackon clinical performance from practitioners. Digital design andmanufacturing, such as 3D printing or CNC machining, is particularlyhelpful in creating custom tool bodies with active clamping forces.

As illustrated in FIGS. 8 a -8 b, the orthodontic appliances 80(illustrated as orthodontic brackets) are already inserted into thereceptacles 90 prior to clamping the facial and lingual bodies 12, 14onto the patient's dental arch. However, the orthodontic appliances 80could be loaded into the open receptacles 90 after the facial andlingual bodies 12, 14 are on the patient's teeth. Likewise, thereceptacles 90 could be preloaded with the intended orthodonticappliances 80 prior to clamping the facial and lingual bodies 12, 14onto the patient's dental arch. Or, after the facial and lingual bodies12, 14 are clamped onto the patient's teeth, the orthodontist may openeach door 40 and place an orthodontic appliance 80 therein.

FIG. 9 illustrates the facial and lingual bodies 12, 14 fitted together.FIG. 10 illustrates the custom dental tool 10 clamped appropriatelyaround the patient's teeth 72 in the mouth 70 of the patient. The firstengagement portions 18 a, 19 a of the facial and lingual bodies 12, 14are interlocked together within the mouth, offset from the occlusalsurfaces of the premolars and extending the direction of the patient'stongue (not shown). Similarly, the second engagement portions 18 b, 19 bof the facial and lingual bodies 12, 14 are interlocked. In theillustrated embodiment, the patient is having orthodontic appliances 80bonded to six teeth.

FIGS. 11 a -11c are convenient for illustrating the method steps forusing the custom tool 10 of the present invention after the custom toolis properly applied in the patient's mouth 70. FIG. 11 a illustratessome of the doors 40 opened to allow access to install an orthodonticappliance 80 into the receptacle 100. For this view, one can see theindividual bases 82 of the orthodontic brackets 80. Also, theorthodontic brackets 80 are inserted into the open receptacle 90. FIGS.11 b illustrates bonding of the orthodontic brackets 80 within thecustom tool 10 to the patient's teeth in the upper dental arch. FIG. 11c illustrates the teeth 72 of the patient's mouth 70 with theorthodontic brackets 80 bonded to the teeth in their ideal locations.The ideal locations for each orthodontic appliance 80 on a tooth arepredetermined by the design process described in more detail below.After the bonding process, the facial and lingual bodies 12, 14 areremoved from the patient's mouth by disengaging their respectiveengagement portions 18, 19 from each other.

During the use of a custom tool 10 for bonding orthodontic appliances80, an adhesive is typically applied to the base 82 of each appliance 80by the orthodontist or a staff member. Although the custom tool 10 isalso useful for adhesive pre-coated orthodontic appliances. Suitableavailable orthodontic appliances are commercially available from 3MCompany based in St. Paul. 3M Company provides ceramic orthodonticbrackets commercially as 3M™ Clarity™ brackets, metal bracketscommercially as Victory Series™ brackets, Unitek™ brackets, andSmartClip™ self-ligating brackets. In addition, suitable commerciallyavailable pre-coated orthodontic appliances or brackets are availablefrom 3M Company based in St. Paul, Minn. as APC™ brackets, APC™ PLUSbrackets, and APC™ Flash-Free brackets. Regardless if a coat of adhesiveis applied to the bracket base or if pre-coated appliances are used,each orthodontic appliance 80 is then placed by use of the receptacle90, 100 to contact the adhesive layer on the base of the appliance 80onto the patient's tooth, and it remains in place until the adhesivehardens. The receptacles 90, 100 allow the orthodontic appliances 80 tobe applied at a direction generally perpendicular to the surface of thetooth, and in turn, helps minimize the potential to smear, or otherwiseinterference with, adhesives applied to the teeth during bonding. Thissituation may be encountered, for example, when using a two-component(or A/B type) chemical cure adhesive where one adhesive component isapplied to the appliance and the other component is applied to thetooth. In contrast, with prior indirect bonding trays more adhesivesmearing can potentially occur on the tooth side when the resultantphysical transfer tray slides onto the patient's teeth from the occlusaldirection towards the gingival direction. It is generally desirable toreduce the degree of adhesive smearing, since smearing can deplete theamount of adhesive at the bonding site and thereby decrease bondreliability. Smearing can also leave an unwanted film of adhesive onportions of the teeth that are not being bonded. After removal of thecustom tool 10 from the patient's teeth, the adhesive used to bond eachappliance 80 to the tooth is typically retained on the base of eachappliance 80, and each appliance 80 is firmly bonded in its intendedlocation.

FIG. 12 illustrates another embodiment of a custom tool 10 for bondingorthodontic appliances, where the custom tool illustrates the twodifferent types of receptacles, an open receptacle 90 and a partiallyenclosed receptacle 100. The open receptacle 90 has an orthodonticappliance 80 mounted within its perimeter. The enclosed receptacle 100has an orthodontic appliance 80 mounted there in (not visible). Theorthodontic appliance 80 has ties wings 84. The facial body and lingualbody 12, 14 are clamped together and have the same configurations ofengagement portions 18 a, 18 b, 19 a, 19 b, and release tables 22 a, 22b as described in great detail above.

All the Figures illustrate a custom tool 10 having receptacles 90, 100for assisting the orthodontist in placing and bonding the appliances 90on the labial surface of the patient's teeth aligned with eachcorresponding receptacle 90, 100. However, the custom tool of thepresent invention may also provide lingual and facial bodies designed toassist in placing and bonding the appliances 80 on the lingual surfaceof the patient's teeth aligned with each corresponding receptacle 90,100.

Different embodiments custom tool 10 for bonding orthodontic appliancesmay be used on a partial to full dental arch in an orthodontic patient'smouth.

Custom tools as described herein may be formed based on a digital modelof the teeth and mouth of an individual patient, which can be producedfrom an intra-oral 3D scan, such as an intraoral scanner. In oneparticular example, the custom tools may be digitally designed using CADsoftware, such as solid modeling software based on the digital model ofthe planned orthodontic treatment. Custom tool was designed to fit overthe teeth to receive orthodontic appliances (the appliance positioningportion) and a portion of the neighboring teeth (the engagementportions). Subsequently, the tooth structure model of the teeth may bedigitally subtracted from a block to create a tool. Alternatively, aninverse of the tooth structure may be inverted within software to definethe block. Engagement portions may be located in regions whichcorrespond to regions of the teeth where they will extend from.

Within the digital model, the body block design may be segmented intotwo sections (facial body and lingual body) to facilitate eventualassembly of the tool components on the teeth, with specific geometricinterferences selected related to the arch lengths to provide desiredthe clamping forces, as discussed above. Within the digital model,engagement portions with certain interlocking geometries are designed,selecting overall heights of the engagement portions based where theengagement portions are placed within the patient's mouth, as discussedin more detail above.

Within the digital model, virtual orthodontic appliances are placed atdesired locations on the teeth of arch model to form a composite model.For one embodiment of the present invention, the orthodontic appliancesare represented by labial brackets. In an alternative embodiment, theorthodontic appliances are represented by lingual brackets. Regardless,the orthodontic appliances including their overall shape andcorresponding bases for attachment to the teeth are directly provided inthe form of an STL file, or other digital image, by the appliancemanufacturer. One suitable appliance manufacture is 3M Company based inSt. Paul. Preferably, the orthodontic appliances are exact virtualreplicas of the physical appliances to be bonded to the teeth of thepatient.

The desired locations for the virtual orthodontic appliances on theteeth of the virtual dental arch model of the patient can be determinedin any of a number of ways. In one example, the treating professionalmanually selects and places the virtual orthodontic appliances directlyon the model using the local computer. In some embodiments, the modelingsoftware treats each appliance and each tooth as a separate objectwithin the 3D environment and fixes the position of each orthodonticappliance within the 3D space relative to a coordinate system associatedwith the tooth of the corresponding appliance. The modeling software canthen, for example, virtually connect the virtual orthodontic appliancesto a virtual arch wire selected by the practitioner and compute thefinal positions of the teeth based on the positions of the orthodonticappliances and the selected arch wire. The modeling software can thendisplay the virtual teeth in their final occlusion for review by thetreating professional.

If the treating professional is not entirely satisfied with the finalpredicted positions of the teeth, the treating professional may use themodeling software to manipulate one or more of the virtual orthodonticappliances relative to the virtual teeth. Based on these adjustments,the modeling software can again virtually connect the virtualorthodontic appliances to the virtual arch wire, for example, tosimulate the movement of teeth to new final positions. The new finalpositions of the teeth, determined by the positions of correspondingvirtual appliances, are then computed and displayed for review. Thesesteps can be repeated as many times as desired until the treatingprofessional is satisfied with the final positions of the teeth asrepresented by the modeling software. As an alternative to movingappliances, the treating professional may instead use the modelingsoftware to define the desired positions of teeth, and have the modelingsoftware determine the suitable locations to place the virtualorthodontic appliances in order to move the teeth to those desiredpositions. Examples of virtual orthodontic treatment are disclosed inissued U.S. Pat. Nos. 6,739,869 (Kopelman et al.), 7,354,268 (Raby etal.) and 7,993,133 (Cinader, Jr. et al.), all of which are herebyincorporated.

As another option, the location of the orthodontic appliances 80 may becarried out by a technician at a location remote from the treatingprofessional's office. For example, a technician at the orthodonticappliance manufacturer's facility may use the modeling software to placeorthodontic appliances on the arch model based on standards orguidelines from an orthodontic treatment philosophy, such as for examplethat of Drs. MacLaughlin, Bennett, and Trevisi taught in text book“Systemized Orthodontic Treatment Mechanics” 1st Edition by Richard P.McLaughlin BS DDS, John C. Bennett FDS RCS, and Hugo Trevisi DDS.

These standards or guidelines for appliance placement may be specific toeach tooth in model, and call out the position of the arch wire slot (anocclusal-gingival height, for example) with respect to the clinicalcrown of each tooth. The technician may also place orthodonticappliances in accordance with particular instructions provided by thetreating professional. Once the technician is satisfied with theorthodontic appliance positions and the resulting finished positions ofthe teeth, the model, together with the data representing the positionsof orthodontic appliances, are transmitted to the treating professionalfor review. The treating professional can then either approve thetechnician's appliance placement positions or reposition the orthodonticappliances as desired.

As yet another option, the local computer can automatically suggestlocations of orthodontic appliances on the teeth to the treatingprofessional. Again, these proposed orthodontic appliance locations areoptionally based upon an orthodontic treatment philosophy or other knownstandards or guidelines in the art. Examples of automatically placingvirtual brackets on teeth are described in issued U.S. Pat. Nos.7,210,929 (Raby et al.), 8,517,727 (Raby et al.) and 7,940,258 (Stark etal.), all of which are hereby incorporated by reference. As before, thetreating professional has the opportunity to review thecomputer-proposed locations of orthodontic appliances and can eitherapprove the placement positions or reposition the orthodontic appliancesas desired.

The complete disclosures of the patents, patent documents, andpublications cited herein are incorporated by reference in theirentirety as if each were individually incorporated. A number of othervariations, modifications and additions are also possible withoutdeparting from the spirit of the invention. Accordingly, the inventionshould not be deemed limited to the specific embodiments describedabove, but instead only by a fair scope of the claims that follow andtheir equivalents.

The following embodiments are intended to be illustrative of the presentdisclosure and not limiting.

Exemplary Embodiments

Embodiment 1 is a custom tool for bonding orthodontic appliances in amouth of a patient, the custom tool comprising: a facial body for apatient-specific, customized fit with the facial side of a plurality ofteeth of the patient, wherein the facial body includes an appliancepositioning portion and a first engagement portion extending away fromthe appliance positioning portion; a lingual body for apatient-specific, customized fit with the lingual side of the pluralityof the teeth of the patient, wherein the lingual body includes a firstengagement portion; wherein the first engagement portion of the facialbody interlocks with the first engagement portion of the lingual body;and wherein the facial body and lingual body are configured to combinewith the teeth of the patient to position orthodontic appliances on theplurality of teeth.

Embodiment 2 is a custom tool of Embodiment 1, wherein the facial bodyincludes a second engagement portion extending away from the appliancepositioning portion, and wherein the lingual body includes a secondengagement portion; and wherein the second portion of the facial bodyinterlocks with the second portion of the lingual body.

Embodiment 3 is a custom tool of embodiment 1, wherein the facial bodyincludes a plurality of receptacles aligned with the plurality of teethto receive an orthodontic appliance.

Embodiment 4 is a custom tool of embodiment 3, wherein the plurality ofreceptacles are apertures designed to each hold an orthodonticappliance.

Embodiment 5 is a custom tool of embodiment 3, wherein the plurality ofreceptacles is enclosed to each hold an orthodontic appliance.

Embodiment 6 is custom tool of embodiment 5, further including aplurality of doors each having an enclosed receptacles for receiving anorthodontic appliance, wherein each door mates with a correspondingaperture positioned adjacent a tooth to receive an orthodonticappliance.

Embodiment 7 is a custom tool of embodiment 1, wherein the mouth of thepatient includes an occlusal plane, and wherein the first engagementportion of the facial body and the first engagement portion of thelingual body extend generally perpendicular to the occlusal plane.

Embodiment 8 is a custom tool of embodiment 1, further including a firstalignment member on the facial body and a second alignment member on thelingual body.

Embodiment 9 is custom tool of embodiment 1, wherein the firstengagement portion of the facial body includes a protrusion and whereinthe first engagement portion of the lingual body includes anindentation, wherein the protrusion of the facial body interlocks withthe indentation of the lingual body adjacent to an occlusal plane of apatient's mouth.

Embodiment 10 is a custom tool of embodiment 1, wherein the firstengagement portion of the facial body includes an indentation andwherein the first engagement portion of the lingual body includes aprotrusion, wherein the protrusion of the lingual body interlocks withthe indentation of the facial body adjacent to an occlusal plane of apatient's mouth.

Embodiment 11 is a custom tool of embodiment 1, wherein the firstengagement portion of the facial body interlocks with the firstengagement portion of the lingual body; and wherein the interlockedportions are configured to provide a clamping force between the facialbody and lingual body.

Embodiment 12 is a custom tool of embodiment 1, wherein the facial bodyincludes a plurality of receptacles aligned with the plurality of teeth,wherein each receptacle is holding an orthodontic appliance.

Embodiment 13 is a custom tool of embodiment 12, wherein the orthodonticappliance is precoated with adhesive.

Embodiment 14 is a custom tool of embodiment 1, wherein each receptableis holding an orthodontic appliance at a predetermined location andpredetermined orientation on its respective tooth.

Embodiment 15 is a method of bonding orthodontic appliances in a mouthof a patient, the method comprising: positioning a patient-specificlingual body adjacent a plurality of teeth of a patient to receiveorthodontic appliances, wherein the lingual body has customized fit withthe lingual side of the teeth of the patient, wherein the lingual bodyincludes a first engagement portion, and; positioning a patient-specificfacial body adjacent the plurality of teeth, wherein the facial body hasa customized fit with the facial side of the teeth of the patient, afirst engagement portion, and a plurality of receptacles each holding anorthodontic appliance aligned with the plurality of teeth; interlockingthe first engagement portion of the facial body with the firstengagement portion of the lingual body to combine with the teeth of thepatient to position the orthodontic appliances on the plurality ofteeth; bonding the orthodontic appliances to the teeth; and removing thefacial and lingual bodies from plurality of teeth.

Embodiment 16 is the method of embodiment 15, wherein the plurality ofreceptacles are apertures each holding an orthodontic appliance.

Embodiment 17 is the method of embodiment 15, wherein the plurality ofreceptacles is enclosed and holding an orthodontic appliance.

Embodiment 18 is the method of embodiment 15, wherein the bonding stepinclude photocuring a layer of adhesive between the orthodonticappliances and the teeth.

Embodiment 19 is a method of designing a custom tool for bondingorthodontic appliances in a mouth of a patient, the method comprising:receiving, by one or more processors, three-dimensional scan dataincluding supragingival tooth structure of a patient; designing, by theone or more processors, a custom tool for precise placement oforthodontic appliances on the patient's teeth based on thethree-dimensional scan data of the supragingival tooth structure of thepatient; designing, by the one or more processors, the orthodonticappliance receptacles to provide desired location and orientation oforthodontic appliances on the tooth structure of the patient; whereinthe tool comprises: a facial body for a patient-specific, customized fitwith the facial side of a plurality of teeth of the patient, wherein thefacial body includes an orthodontic appliance positioning portion and afirst engagement portion extending away from the positioning portion; alingual body for a patient-specific, customized fit with the lingualside of the plurality of teeth of the patient, wherein the lingual bodyincludes a first engagement portion extending away from the customfitting portion; wherein the first engagement portion of the facial bodyinterlocks with the first engagement portion of the lingual body; andwherein the facial body and lingual body are configured to combine withthe teeth of the patient to position orthodontic appliances on theplurality of teeth.

1. A custom tool for bonding orthodontic appliances in a mouth of apatient, the custom tool comprising: a facial body for apatient-specific, customized fit with the facial side of a plurality ofteeth of the patient, wherein the facial body includes an appliancepositioning portion and a first engagement portion extending away fromthe appliance positioning portion; a lingual body for apatient-specific, customized fit with the lingual side of the pluralityof the teeth of the patient, wherein the lingual body includes a firstengagement portion; wherein the first engagement portion of the facialbody interlocks with the first engagement portion of the lingual body;and wherein the facial body and lingual body are configured to combinewith the teeth of the patient to position orthodontic appliances on theplurality of teeth.
 2. The custom tool of claim 1, wherein the facialbody includes a second engagement portion extending away from theappliance positioning portion, and wherein the lingual body includes asecond engagement portion; and wherein the second portion of the facialbody interlocks with the second portion of the lingual body.
 3. Thecustom tool of claim 1, wherein the facial body includes a plurality ofreceptacles aligned with the plurality of teeth to receive anorthodontic appliance.
 4. The custom tool of claim 3, wherein theplurality of receptacles are apertures designed to each hold anorthodontic appliance.
 5. The custom tool of claim 3, wherein theplurality of receptacles is enclosed to each hold an orthodonticappliance.
 6. The custom tool of claim 5, further including a pluralityof doors each having an enclosed receptacles for receiving anorthodontic appliance, wherein each door mates with a correspondingaperture positioned adjacent a tooth to receive an orthodonticappliance.
 7. The custom tool of claim 1, wherein the mouth of thepatient includes an occlusal plane, and wherein the first engagementportion of the facial body and the first engagement portion of thelingual body extend generally perpendicular to the occlusal plane. 8.The custom tool of claim 1, further including a first alignment memberon the facial body and a second alignment member on the lingual body. 9.The custom tool of claim 1, wherein the first engagement portion of thefacial body includes a protrusion and wherein the first engagementportion of the lingual body includes an indentation, wherein theprotrusion of the facial body interlocks with the indentation of thelingual body adjacent to an occlusal plane of a patient's mouth.
 10. Thecustom tool of claim 1, wherein the first engagement portion of thefacial body includes an indentation and wherein the first engagementportion of the lingual body includes a protrusion, wherein theprotrusion of the lingual body interlocks with the indentation of thefacial body adjacent to an occlusal plane of a patient's mouth.
 11. Thecustom tool of claim 1, wherein the first engagement portion of thefacial body interlocks with the first engagement portion of the lingualbody; and wherein the interlocked portions are configured to provide aclamping force between the facial body and lingual body.
 12. The customtool of claim 1, wherein the facial body includes a plurality ofreceptacles aligned with the plurality of teeth, wherein each receptacleis holding an orthodontic appliance.
 13. The custom tool of claim 12,wherein the orthodontic appliance is precoated with adhesive.
 14. Thecustom tool of claim 1, wherein each receptable is holding anorthodontic appliance at a predetermined location and predeterminedorientation on its respective tooth. 15-19. (Canceled)